NCAA dreams of database tracking concussions for every college athlete

The NCAA wants to eventually create a centralized concussion database of every college athlete, NCAA chief medical officer Brian Hainline said in an interview this week with AL.com.

No formal plans have been announced, but Hainline said he has been focusing on the database for months. The concept won't be easy, "but that's the direction I firmly want to go," he said.

The widespread, systemic collection of sports-related concussion data at all levels has been a challenge for scientists. The lack of larger sample sizes gets cited by some policymakers in sports for not taking more actions related to concussions.

Hainline's dream is to have baseline data of cognitive functioning for all 450,000 college athletes -- he said about 90 percent of NCAA schools currently take baselines -- and get updated data points after every event to chart the progression of concussions. Hainline said he is also trying to link NCAA schools into existing MRI studies about biomarkers for concussions. Locating biomarkers, either through MRIs or blood tests, could show an individual's genetic susceptibility to sustaining a concussion and longterm brain injuries.

Hainline has been working on research ideas with Col. Dallas Hack, director of the Army's Combat Casualty Care Research Program. At a December meeting with 10 military scientists and 10 scientists from NCAA universities, Hainline and Hack asked the group what a dream concussion project would look like if given $30 million to spend.

"That was a three-hour discussion and there was unanimous consensus in the room what's still lacking is no one understands the progression of a concussion's history," Hainline said.

There are obstacles to the NCAA database. For starters, the research would have to be done in compliance with the Health Insurance Portability and Accountability Act (HIPAA), which protects the privacy of individually identifiable health information.

To execute the database properly, Hainline said all 1,100 member schools must have an approved institutional review board to conduct research of humans. All of the information would need to be uploaded into the same centralized database and properly analyzed to make sure the information is valid.

"To really get this off the ground I think is going to be closer to a three-year project," Hainline said. "The last thing we want to do is roll out a project like HealthCare.gov. We're going to start small and work with about a dozen schools."

The database is a longterm goal for the NCAA. In the short term, Hainline said he wants college sports to become unified by the 2014-15 academic year on a number of concussion issues, such as football practice hitting guidelines, updated concussion management guidelines, and ensuring a medical environment is free of conflict of interest.

Schools are required to have concussion management plans, but the NCAA doesn't enforce them. Rep. Linda Sanchez asked the NCAA last November how it attempts to protect players in regard to head injuries, including what the NCAA does to ensure that schools follow their concussion plan.

In order to adapt to science, Hainline said he prefers schools handle concussions based on "best practices" rather than the NCAA legislating mandatory rules.

Brian Hainline prefers "best practices" on how schools should handle concussions rather than mandatory rules.

"The question is do we become a large enforcement agency, or do we set up more nimble best practices that shift as our knowledge shifts so that we can change within a month or two instead of a year or two?" Hainline said. "(Being nimble) would be my preference. There are arguments for both ways."

A draft of updated concussion management guidelines is being reviewed internally by the NCAA, Hainline said. The guidelines will later be distributed to member universities and medical organizations.

"I'm reasonably confident by sometime around June we're going to have a very broad consensus working across the board as opposed to the NCAA saying, 'This is what we're going to do,' and fight an uphill battle," Hainline said. "I'd rather do the fighting upfront and then have everyone holding hands at the end. ... I'm really trying to get wide buy-in from everyone in moving in the same direction because that's the only way I really think we can change the culture."

How much hitting in football practices should be allowed?

Two weeks ago in Atlanta, the NCAA and College Athletic Trainers' Society co-sponsored a summit about college sports safety with many stakeholders. They included representatives from the five major Division I conferences, Division II, Division III, the American Football Coaches Association, the National Athletic Trainers' Association and the American Medical Society for Sports Medicine, among others.

Among the topics discussed: hitting restrictions in football practices. The Ivy League and Pac-12 have tighter restrictions than other leagues and the NCAA, following the NFL's pattern of cutting back on allowable hitting at practice.

Reports from some schools showed there are less concussions at half-contact practices, Hainline said. Two teams tracking practice data reported large increases in shoulder injuries during the past year as football tries to remove the head from tackling, he said. Hainline said those injuries suggest some players are not utilizing their shoulder properly while adjusting to a new tackling technique.

"It's not about just pulling a magic number out and saying this is how many full-contact or half-contact practices there should be," Hainline said. "I think there will be a number. It's more about how do we monitor it and pay attention to all of the variables?"

Also discussed at the summit was how to make sure medical officials are diagnosing head injuries based on the health of a player, not a competitive interest for the player to return to action.

"It really has to do with hiring and firing and who monitors," Hainline said. "If it's a coach, that's a conflict. If it's a student-athlete health services or medical center, then that's not a conflict. Some of it is really simple. ... There should be no pressure from a non-medical entity like a coach or administrator to get a player back to the game. The tricky part is moving that to really something that's widely practiced."